Dual-eligible Medicare-Medicaid status is associated with lower surgeon reimbursement despite greater medical and psychosocial complexity in total shoulder arthroplasty.

Background: Dual eligibility for Medicare and Medicaid is a well-established marker of socioeconomic vulnerability, but its association with health disparities in total shoulder arthroplasty (TSA) has not been evaluated. This study aimed to evaluate whether the proportion of dual-eligible beneficiaries in TSA surgeons' Medicare panels was associated with standardized Medicare reimbursement. Methods: A retrospective, cross-sectional analysis of the publicly available "Centers for Medicare and Medicaid Services Physician and Other Practitioners" file for 2023 was performed. Surgeons performing primary TSA were identified using Current Procedural Terminology code 23472. Surgeon-level dual-eligibility proportion was defined as the percentage of dual-eligible beneficiaries within each surgeon's Medicare patient panel and categorized into quartiles. Outcomes included TSA volume and mean standardized Medicare reimbursement per TSA. Surgeon panel characteristics, including Hierarchical Condition Category score, minority composition, and behavioral health conditions (anxiety and depression), were also assessed. Results: A total of 3,439 surgeons performing 93,167 primary TSA procedures were identified, of which, 2,623 surgeons had data available for all variables used in quartile-based analyses. The mean TSA volume per surgeon was 27.09 ± 19.42 cases. Higher dual-eligibility proportion was independently associated with lower standardized reimbursement per TSA (lowest quartile [Q1]: $936.20 vs. highest quartile [Q4]: $799.18; Conclusion: Surgeons with higher proportions of dual-eligible beneficiaries in their Medicare panels receive lower standardized reimbursement while managing more medically and psychosocially complex patient panels. These findings suggest that the current reimbursement structure may create financial disincentives for surgeons treating this socioeconomically vulnerable population, with implications for equitable access to TSA care.